Healthcare Provider Details

I. General information

NPI: 1336481910
Provider Name (Legal Business Name): MARISELA E. ELLIOTT LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELA ELLIOTT LCSW, LAC

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 N 12TH ST
GRAND JUNCTION CO
81501-2916
US

IV. Provider business mailing address

2140 N 12TH ST
GRAND JUNCTION CO
81501-2916
US

V. Phone/Fax

Practice location:
  • Phone: 970-579-0003
  • Fax: 970-433-7671
Mailing address:
  • Phone: 970-209-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0002107
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7826-M
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929257
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: